Diabetes drugs like Ozempic and Wegovy have taken the world by storm, promising to revolutionize the way people lose weight.
Soaring sales have led to a major windfall for Novo Nordisk, the Danish drug maker that produces both drugs. This year, the company’s market value surpassed Denmark’s GDP and led to an economic boom in its home country.
That growth has another side effect: The success of the drugs is tilting the scales of global philanthropy.
The Novo Nordisk Foundation is now the world’s wealthiest grant maker, with more than $114 billion in assets. That’s more than the combined endowments of the Bill & Melinda Gates Foundation, which ranks second among the largest foundations, and the London-based Wellcome Trust, the medical research grant maker that ranks third.
But as foundation CEO Mads Krogsgaard Thomsen explained in an interview, it’s not really an apples-to-apples comparison. The Novo Nordisk Foundation is considered a “shareholder foundation” or “enterprise foundation,” meaning that it controls a majority stake in the corporate entities Novo Nordisk and Novozymes. That means unlike other mega-foundations, only about 20 percent of Novo Nordisk’s assets are accessible for philanthropic purposes. That corporate structure is uncommon in the U.S. but has existed in Europe for decades.
Still, the foundation bears watching as its grant making rapidly expands in the U.S. and beyond. In 2022, the foundation awarded $1.04 billion in grants, nearly double the amount awarded in 2018. That number is expected to continue to grow in the coming years, says Thomsen, who has led the foundation since 2021.
Thomsen, who previously supervised the development of Wegovy and Ozempic as the company’s chief scientific officer, spoke to the Chronicle from Copenhagen. He discussed how the grant maker has expanded its global reach, why it’s supporting a wider array of health and environmental causes, and the value he sees in collaborating with U.S. grant makers like the Bill & Melinda Gates Foundation and Open Philanthropy.
This interview was edited for length and clarity.
Based on assets, the Novo Nordisk Foundation is the largest grant maker in the world. Is it fair to make a comparison between Novo Nordisk and other major philanthropies like the Gates Foundation?
It’s not quite comparable. The difference is that we are an enterprise foundation and we exist in perpetuity. We are going to turn 100 years old next year, but we intend to stay around for the next 100 years after that.
Part of our wealth is in shares in the Novo Group companies. These shares are not ones we can really dispose of because we are under the obligation to have a controlling ownership of the companies. The parts of our assets that are not tied up in shares or reserves is around $22 billion.
If you look at Bill Gates and Melinda and their foundation, it’s their personal wealth, and they intend to hand out most of it over the next couple of decades. So they are able to actually allocate even more funds for philanthropy than the Novo Nordisk Foundation.
Analysts estimate the global market for diabetes and weight-loss drugs could grow as high as $100 billion in the next decade, and Novo Nordisk’s drugs — such as Wegovy, Ozempic, and Rybelsus — could capture nearly half of market share. If that pans out, how will that affect grant making in the next decade?
Due to the growth in the value of the Novo Group companies, it is foreseeable that the work of the foundation will continue to grow throughout the decade, which gives us ample opportunity to increase our philanthropic grants and investments in the next many years to come.
What’s driving the increasingly global grant-making strategy?
In order to achieve absolutely world-class results, you need to team up with the smartest people and technologies wherever they may be.
So one example is, if you want to do something about obesity and diabetes and cardiometabolic disease, why don’t you couple our Center for Basic Metabolic Research with the Broad Institute in Boston, because they’re leaders in understanding the genetics of disease? So we gave a $47.5 million grant to the Broad Institute of MIT and Harvard under the assumption that we would be collaborating heavily.
You get the best of two worlds, and you have a chance to understand these diseases — obesity and Type 2 diabetes — by the root causes. It’s a much better way than to work in isolation.
Your U.S. grant making has grown from less than $1 million to $44 million in 2021 and $24 million in 2022. How is the foundation collaborating with grant makers in the U.S.?
I met Bill Gates just after having joined the foundation and we quickly realized there are things that we can do better in collaboration. First we did the Pandemic Antiviral Drug Discovery program together with the Gates Foundation and Open Philanthropy. More recently, we realized both Bill and I read an article about how you can actually turn bad carbon, like CO2, into something that can replace sugar in the fermentation industry and be turned into protein for human food.
We decided to do a rather big project ($29 million), and this means that we are sending half the money to U.S. institutions, and Bill and his team are sending money to Denmark.
Bill and Melinda also wanted to do something with us on women’s health, so they gave a grant to our BioInnovation Institute, and they have now multiplied that by a factor of five to create innovative startup companies and do women’s health research in Denmark.
How has the scope of causes the foundation supports broadened?
When I started, I thought it would be much more fun to start a new strategy so that I can see it come to fruition during my tenure throughout this decade.
There were a lot of philanthropic organizations supporting human health, infectious diseases, and whatnot, but very little when it comes to planetary health or sustainability. It sounded natural to me to create a strategy that had two major global focus areas: human health and planetary health.
With human health, we’ve tried to fund research areas where we are strong, which is cardiometabolic disease, infectious disease, and regenerative medicine based on stem cells. With planetary health it was about creating climate mitigating solutions that were scalable and commercially viable, like CO2 mitigation, but also creating a sustainable agriculture and food system that benefits people and plants.
We still have more investments in human health, but it is becoming more balanced as time goes by.
We also want to nurture the life-science ecosystem, and that’s independent of human and planetary health. For example, with $200 million we created a quantum computing center at the Niels Bohr Institute that wants to make the world’s first quantum computer that can solve life-science mysteries. One day we can use a quantum computer to understand how to make fertilizer at room temperature instead of 500 degrees centigrade. Or you can use a quantum computer for drug discovery for human health.
You also have a major vaccine initiative in the works. What will that look like?
We want to create solutions for the next serious outbreaks. The dream for the Initiative for Vaccines and Immunity is to create a center where academics and biotech companies come together and make available their vaccine platform to be tested out up against each other. Based on which vaccine platform works best against which pathogen, we will then scale that up and have it ready for when there’s a need for it in the world.
One of the world’s leading vaccine researchers, Peter Lawætz Andersen, is now head of our infectious-disease area at the foundation. His ambition has been to say what went well and less well with Covid-19. Within a year we had a vaccine that worked — the mRNA vaccines whose developers just won the Nobel Prize. However, that vaccine only works for some months, it doesn’t protect against transmission from person to person, and it doesn’t protect against all the different variants of the virus.
At the same time, we will have a major focus on airborne pathogens like influenza and tuberculosis. We’ll research how the human respiratory tract defends us against airborne pathogens. We always inject vaccines into the human body under the skin or in the muscle. The immune system creates antibodies, the antibodies circulate, a few of them make it all the way into the airways, but most of them don’t. That is why most vaccines do not block transmission.
Maybe the future course will be a systemic vaccination with a jab in the arm, as we’re used to, and then the next vaccination is a nasal or an aerosol deposition right into the airways. We will work in collaboration with academics, with other foundations, with bio-tech companies, and of course with Gavi, the Vaccine Alliance and other multinational institutions.
When you made the move to the foundation was there anything that surprised you about how the philanthropic world works?
When I would go to World Economic Forum or somewhere else as a pharma R&D chief, I met a very narrow group of people. You are seen as an industry member, as a profitable company that wants to make money. When you are heading up a major global foundation, you meet everyone — ministers from not only Denmark but also from other countries — and they are often more senior because they want to work with philanthropy.
More and more, we are really seen as a serious sparring partner for governments, and that has taken me by surprise. The Covid-19 pandemic has proved the value of public-private partnerships, including those between the public and philanthropy.
Reporting for this article was underwritten by a Lilly Endowment grant to enhance public understanding of philanthropy. The Chronicle is solely responsible for the content. See more about the Chronicle, the grant, how our foundation-supported journalism works, and our gift-acceptance policy.
